Cognitive Fatigability Interventions in Neurological Conditions: A Systematic Review

Abstract

IntroductionAlthough fatigue is a well-studied concept in neurological disease, cognitive fatigability (CF) is less understood. While most studies measure fatigue using subjective self-report, fewer have measured CF objectively. Given the negative impact of CF on quality-of-life, there is a need for targeted interventions. The objective of this review was to determine which procedural, behavioural and pharmacological treatments for objectively measured CF are available to people living with neurological conditions.MethodsIn accordance with the PRISMA guidelines, systematic searches for randomized control trials (RCTs), case-controlled studies and case reports/series were conducted across the Ovid Medline, PsycInfo, EMBASE and Cochrane Library databases. English-language articles published between 1980 and February 2019 were considered for eligibility. Included were those that objectively measured CF in individuals with neurological disease/disorder/dysfunction between the ages of 18 and 65 years. Studies were reviewed using a modified Cochrane Data Extraction Template. Risk of bias was assessed using the Cochrane Risk of Bias tool. The review process was facilitated using Covidence software (www.covidence.org). Two authors reviewed articles independently, with a third resolving conflicts regarding article inclusion.ResultsThe search identified 450 records. After duplicates were removed and remaining titles/abstracts were screened for eligibility, 28 full-text articles were assessed, and two studies were included in the qualitative synthesis. Studies were a priori divided into those with pharmacological, procedural or behavioural interventions. Two studies met eligibility criteria; both of these included participants with multiple sclerosis. One study utilized a procedural intervention (i.e. transcranial direct current stimulation), while the other utilized a pharmacological intervention (i.e. fampridine-SR). Studies were evaluated for risk of bias, and evidence from both eligible studies was discussed.ConclusionDespite the positive results of the procedural intervention, the paucity of eligible studies and the nascent nature of the field suggests that more studies are required before firm conclusions can be drawn regarding the amenability of CF to treatment.Trial registrationThe review was registered with PROSPERO (CRD42019118706).Electronic supplementary materialThe online version of this article (10.1007/s40120-019-00158-3) contains supplementary material, which is available to authorized users.

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“…Fatigue is the most common disabling symptom in MS affecting over 80% of persons with MS. For many it is the most challenging to manage on a daily basis, and 40% of those with MS consider it their most disabling symptom resulting in decreased quality of life and a significant reason for forfeiture of a vocation or employment (Blikman et al, 2018;Braley & Chervin, 2010;Halper & Harris, 2017;Marshall & Mayer, 2007;Morrison & Stuifbergen et al, 2016;Tedeschi et al, 2007;Touzet, 2017;Vaughn, et al, 2018;Walker et al, 2019). The purpose of this integrative review was to understand new developments about the dimensions of cognitive fatigue, especially its causes and evaluations, in order to detect its manifestations and intervene accordingly.…”

“…Fatigue in the general population is described as an overpowering sense of exhaustion resulting in less reserves for physical and mental work at a person's usual level of functioning (Given & Sherwood, 2006). Researchers have regarded general fatigue as an individual subjective phenomenon that is described as a shortage of energy after engaging in physical or mental activities and is usually measured by self-report (Walker et al, 2019). MS fatigue has been defined by the Multiple Sclerosis Council for Clinical Practice Guidelines (Blikman et al, 2018) as being associated with a person's physical behavior, daily physical functioning, and activities accomplished in daily life.…”

“…As research evolved related to MS, questionnaires were developed for self-reporting with attempts to quantify fatigue and evaluate its impact on day to day functioning for persons with MS (Walker et al, 2019). Walker et al (2019) listed scales that were developed between 1989 and 2012, e.g., Fatigue Severity Scale, Fatigue Impact Scale, Neurological Fatigue Index, Mental Fatigue Scale, Fatigue Assessment Scale, Multidimensional Fatigue Inventory, and the Fatigue Scale for Motor and Cognitive Functions. Objective measurement leads to quantification of cognitive fatigue, thereby, positively impacting disability benefits for people afflicted with MS related cognitive fatigue (Walker et al, 2019).…”

“…Walker et al (2019) listed scales that were developed between 1989 and 2012, e.g., Fatigue Severity Scale, Fatigue Impact Scale, Neurological Fatigue Index, Mental Fatigue Scale, Fatigue Assessment Scale, Multidimensional Fatigue Inventory, and the Fatigue Scale for Motor and Cognitive Functions. Objective measurement leads to quantification of cognitive fatigue, thereby, positively impacting disability benefits for people afflicted with MS related cognitive fatigue (Walker et al, 2019). Harrison et al (2017) recommended that these measures be further explored and improved.…”

“…The search strategy identified 331 potential articles. Hand search of systematic reviews (Walker et al, 2019) added nine titles and an additional study by Vaughn et al (2018). The author of this integrative review attended a lecture presentation given by Vaughn and found the article written by her and her colleagues relevant to this review.…”